For those who work in environments where codes from category V57 (care involving use of rehabilitation procedures) are a staple, you be surprised to learn that when it comes to ICD-10-CM, all V57 codes map to the same ICD-10-CM code (Z51.89). In ICD-9-CM, the codes within category V57 help to identify a variety of therapies that providers administer to patients:
- V57.0 (breathing exercises)
- V57.1 (other physical therapy [except breathing exercises])
- V57.2x (encounters for occupational or vocational therapy)
- V57.3 (speech-language therapy)
- V57.4 (orthoptic training)
- V57.8x (orthotic and other training or therapy)
- V57.9 (unspecified rehabilitation procedure)
An instructional note corresponding to category V57 codes states that coders should assign an additional code for the underlying condition or reason for such rehab procedures (e.g., late effect of cerebrovascular accident with aphasia, hemiplegia, or aftercare of a fracture).
When referencing the ICD-9-CM to ICD-10-CM general equivalency mappings (affectionately called “GEMs”), all of these codes (that by the way have some specificity in ICD-9-CM) map only to one ICD-10-CM code Z51.89 (encounter for other specified aftercare). There is an instructional note in ICD-10-CM that states to “code also condition requiring care,” but does this diagnosis really identify whether the therapy provided was physical therapy, occupational therapy, or vocational therapy? Not so much.
This concept is important because the American Hospital Association’s (AHA) Coding Clinic, Third Quarter, 2006, instructed inpatient rehab hospitals to use a V57 code as the principal diagnosis. We know that the AHA is not going to translate the ICD-9-CM Coding Clinics to ICD-10-CM, but for the sake of rehab hospitals I do hope that some guidance is provided sooner than later if they are not to assign the encounter for rehab code as the principal diagnosis. Maybe the thought is that ICD-10-CM code Z51.89 identifies with as much detail as is necessary for reporting for inpatient rehab? If we still are to assign additional codes for the conditions requiring care then it should be ok, right?
Clearly we found a reason to have specific codes in ICD-9-CM, so maybe we ought to stay tuned for more specificity to filter over into the ICD-10-CM codes for inpatient admissions for rehab.